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A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England

BRITISH DENTAL JOURNAL 2000年第10期188卷 554-558页

作者： Palmer, NAO Pealing, R Ireland, RS Martin, MV Univ Liverpool Dept Clin Dent Sci Liverpool L69 3BX Merseyside England

Objective To study the therapeutic prescribing of antibiotics by general dental practitioners. Design A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. Subjects General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaire were received from 929 (60.1 %) practitioners. More than 95 % of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5 %) prescribed antibiotics for acute pulpitis and (3.3 %) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69 %) and by 23 % after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92 %), but would prescribe when under pressure of time (30.3 %), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5 %). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. Conclusions The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in Nation

关键词：脓肿/外科学急性病阿莫西林/治疗应用抗菌药/治疗应用抗感染药/治疗应用细菌感染/药物疗法慢性病牙医病人关系引流术药物处方/统计学和数值数据药物利用/统计学和数值数据干槽症/药物疗法英格兰/流行病学开业医生牙科/统计学和数值数据牙龈炎/药物疗法牙龈炎坏死溃疡性/药物疗法甲硝唑/治疗应用青霉素类/治疗应用冠周炎/药物疗法牙髓炎/药物疗法公费医疗/统计学和数值数据女(雌)性人类男(雄)性

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Impact of older adults on private dental practices, 1988-1998

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第8期131卷 1188-1195页

作者： Meskin, L Berg, R Univ Colorado Sch Dent Dept Appl Dent Denver CO 80262 USA Univ Colorado Sch Dent Adv Clin Training & Serv Program Denver CO 80262 USA

Background, A 1988 study indicated that older adults made up a substantial portion of regular patients seen in private dental practices. A follow-up study was conducted in 1998 to track changes over the decade in the participating practices. Methods, The authors collected data from respondents to the 1988 survey again in 1998. The authors received complete data from 41.7 percent of the original respondents who still were practicing at their 1988 addresses. Dentists kept a log of all procedures provided in their practices in one day. The authors attributed values of services in both years, using a 1997 national estimate of fees. Results, The authors found that the percentage of office visits, services provided and patient expenditures attributed to patients 65 years of age or older exceeded the percentage of the population in that age group. In four of the five age groups in which patients had the highest mean expenditures, patients were 60 years of age or older. Patients 60 years of age or older accounted for 28.8 percent of all patient expenditures, a 12.1 percent increase from 1988. Longitudinal analyses indicated that between 1988 and 1998, dentists 40 years of age or older experienced increases of 30.3 to 64.3 percent in the proportion of visits, services and expenditures by patients 65 years of age or older. Conclusions, The results of this investigation illustrate the importance of older adults to dental practices. Data from the practices of dentists who participated in both surveys show increases in the percentage of total dental visits, total eel-vices provided and total patient expenditures attributed to older adults. Clinical Implications, Older adults continue to have a disproportionate and positive impact on the surveyed dental practices and their financial well-being. Dentists should reevaluate the accessibility of their practices to this population. Rather than waiting for the practice to "age," dentists may want to structure their practices in ways th

关键词：队列研究老年人牙科医疗/经济学老年人牙科医疗/统计学和数值数据卫生经费支出/统计学和数值数据 Logistic模型人口动力学诊疗工作管理牙科/经济学诊疗工作管理牙科/统计学和数值数据美国成年人老年人人类中年人

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Referrals for dental general anaesthetics - How many really need GA?

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BRITISH DENTAL JOURNAL 1999年第8期187卷 440-443页

作者： Tyrer, GL Birch Hill Hosp Community Dent Off Rochdale OL12 9QB England

Aim To fmd out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. Design Analysis of clinical outcomes supported by telephone canvassing of parents. Method In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished. Results In 75% of cases it proved possible to complete the extractions without need for DGA;in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received. Conclusion There is score for significant reduction. in provision of dental general anaesthesia if current professional guidelines are followed.

关键词：年龄因素麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据麻醉局部/统计学和数值数据龋齿/治疗采访(主题) 病人遴选转诊和会诊/统计学和数值数据危险性评估拔牙治疗结果青少年儿童儿童学龄前人类

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Factors influencing the diagnosis and management of teeth with pulpal and periradicular disease by general dental practitioners. Part 2

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BRITISH DENTAL JOURNAL 1999年第10期187卷 548-554页

作者： Saunders, WP Chestnutt, IG Saunders, EM Univ Glasgow Sch Dent Glasgow G2 3JZ Lanark Scotland Univ Dundee Sch Dent Dundee DD1 4HN Scotland Lanarkshire Hlth Board Dept Dent Publ Hlth Hamilton ON Canada

Objective To identify techniques commonly used in the management of periradicular disease by general dental practitioners and to ascertain views on continuing professional education in endodontics. Design Data was collected via a postal questionnaire distributed to 617 general dental practitioners in Scotland (33% of practitioners registered with the Dental Practice Board). Results 417 (69%) questionnaires were completed and returned. Only 24.9% of respondents used rubber dam routinely. The majority of respondents used hand instruments for preparation with either sodium hypochlorite or local anaesthetic being used most frequently for irrigation. The mean time for treatment of a single rooted tooth was 71 minutes. The demand for continuing education courses was high with 340 and 197 respondents requesting endodontic and rubber dam courses, respectively. Conclusions Traditional methods for preparing the root canal using hand instruments were favoured by most dentists. The major disincentive to the use of rotary instruments and new techniques for obturating with thermally softened gutta-percha was expense. The importance of rubber dam isolation requires reiteration and more continuing education courses are required to update clinical skills.

关键词：牙髓疾病/诊断牙髓疾病/治疗牙医师/统计学和数值数据开业医生牙科/仪器和设备开业医生牙科/方法开业医生牙科/统计学和数值数据根尖周疾病/诊断根尖周疾病/治疗根管疗法/仪器和设备根管疗法/方法根管疗法/统计学和数值数据橡皮障苏格兰人类

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Development and preliminary evaluation of an instrument designed to assess dental students' communication skills.

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BRITISH DENTAL JOURNAL 2000年第1期188卷 40-44页

作者： Theaker, ED Kay, EJ Gill, S Univ Manchester Dept Dent Med & Surg Manchester M15 6FH Lancs England

The aim of this study was to develop, and assess the inter-observer reliability of an instrument for evaluating dental students' communication skills. Methods used were process-tracking of interactions between experienced practitioners and patients, development of the instrument and its simultaneous use by two researchers observing 43 third year dental students prior to communication skills training. The results found that the instrument was appropriate for the purpose for which it was designed, and was easy to utilise. There were no significant differences between observers' total scores. Item-specific weighted kappa scores showed almost perfect agreement between observers for all but four of the 31 items. The lowest interobserver weighted kappa score was for the measurement of eye contact (k = 0.60). In conclusion, assessment of communication skills is now a necessity in the undergraduate curriculum. Preliminary analysis of an instrument of communication skills in the dental surgery indicates that it may be possible to do this reliably.

关键词：临床工作能力/统计学和数值数据信息交流牙医病人关系教育考核/方法评价研究(主题) 结果可重复性学生牙科/心理学学生牙科/统计学和数值数据人类

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Efficacy of articaine: A new amide local anesthetic

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第5期131卷 635-642页

作者： Malamed, SF Gagnon, S Leblanc, D Univ So Calif Sch Dent DEN 4302 Los Angeles CA 90089 USA IBAH Inc Med Affairs Blue Bell PA USA Specialites Septodont St Maur Des Fosses France

Background, The authors compared the safety and efficacy of 4 percent articaine with epinephrine 1:100,000 with 2 percent lidocaine with epinephrine 1:100,000. Methods, In three identical randomized, double-blind, multicenter trials, subjects 4 to 80 years of age received either 4 percent articaine with epinephrine 1:100,000 or 2 percent lidocaine with epinephrine 1:100,000 for simple or complex dental procedures. In each trial, the authors randomized the subjects in a 2:1 ratio to receive articaine or lidocaine. Efficacy was determined by both subject and investigator using a visual analog scale, or VAS. The authors used the Kruskal-Wallis test to analyze the data. Results, A total of 882 subjects received articaine, and 443 received lidocaine. The authors found no statistical differences between the groups (P = .05). They also compared drug volumes for both articaine and lidocaine groups (2.5 milliliters +/- 0.07 standard error of mean, or SEM, vs. 2.6 mL +/- 0.09 SEM for simple procedures and 4.2 mL +/- 0.15 SEM vs. 4.5 mL +/- 0.21 SEM for complex procedures). The procedures' durations were comparable for both the articaine and lidocaine groups. The authors found no statistical difference between the two treatment groups (P = .05) with respect to subject or investigator pain ratings using the VAS;the mean pain scores determined by both patients and investigators for all groups tested were less than 1.0, Conclusions, The authors found that 4 percent articaine with epinephrine 1:100,000 was well-tolerated in 882 subjects. It also provided clinically effective pain relief during most dental procedures and had a time to onset and duration of anesthesia appropriate for clinical use and comparable to those observed for other commercially available local anesthetics. Clinical Implications. Pain control is a major component of patient comfort and safety. Local anesthetics form the backbone of pain control techniques in dentistry. Four percent articaine with epinephrine i

关键词：麻醉牙科/方法麻醉牙科/统计学和数值数据麻醉药局部/投药和剂量麻醉药局部/副作用卡替卡因/投药和剂量卡替卡因/副作用双盲法肾上腺素/投药和剂量肾上腺素/副作用利多卡因/投药和剂量利多卡因/副作用美国青少年成年人老年人老年人 80以上儿童儿童学龄前人类中年人

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Survey of US dentists' knowledge and opinions about oral pharyngeal cancer

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第5期131卷 653-661页

作者： Yellowitz, JA Horowitz, AM Drury, TF Goodman, HS NIDCR NIH Bethesda MD 20892 USA Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA Maryland Dept Hlth & Mental Hyg Off Oral Hlth Baltimore MD USA

Background, Oral pharyngeal cancer constitutes the most life-threatening of all dental and craniofacial conditions. The U.S. five-year survival rate of 52 percent for these cancers is one of the lowest and has not changed in decades. Methods. The authors mailed a pretested survey to 7,000 randomly selected general dentists;They obtained information on 3,200 dentists' levels of knowledge about oral pharyngeal cancer risks and diagnostic procedures for providing an oral cancer examination, as well as about related opinions and interest in continuing education, or CE, courses on the topic. The authors carried out analyses using unweighted data;they used both bivariate and logistic analytical techniques and evaluated at a significance level of P less than or equal to .01. Results. Based on responses to 14 questions, the average knowledge of oral cancer risks score was 8.4. About one-half of dentists surveyed knew the two most common sites of intraoral cancer and that most oral cancers are diagnosed at a late stage. Conclusions. The reported knowledge of these dentists regarding oral cancer suggests that they are not as knowledgeable as they could be about cancer prevention and early detection and that they recognize these deficiencies. Most of the dentists were interested in oral cancer CE. Clinical Implications. Dentists need to know where in the mouth to look and what types of lesions to look for to provide a comprehensive oral cancer examination.

关键词：医务工作者的态度临床工作能力/统计学和数值数据牙医师/心理学牙医师/统计学和数值数据牙医师女/心理学牙医师女/统计学和数值数据教育牙科继续开业医生牙科/统计学和数值数据口腔肿瘤/诊断咽肿瘤/诊断危险因素美国成年人女(雌)性人类男(雄)性中年人

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Social background of minority ethnic applicants to medicine and dentistry

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BRITISH DENTAL JOURNAL 2000年第3期189卷 152-154页

作者： Bedi, R Gilthorpe, MS UCL Eastman Dent Inst Natl Transcultural Oral Hlth WHO Collaborating Ctr Disabil Culture & Oral Hlth London WC1X 8LD England

Aim To explore ethnic variations in social background of successful applicants to undergraduate United Kingdom medical and dental schools. Method Retrospective analyses of University and College Admissions Services data on all students to commence study in pre-clinical medicine and dentistry, during the academic years 1994/5, 1995/6 and 1996/7. Analyses were undertaken for two categories of social class, namely higher (professional and intermediate) and lower (skilled non-manual, skilled manual, partly skilled, and unskilled) social class. Results Over 15 thousand students were accepted to study medicine and dentistry during the three-year study period, of which 80% were from high social class backgrounds. More medical (80.9%) students were from high social class backgrounds than dental (73.3%) students (OR=1.54, 95% CI=1.39, 1.70). Social class differences were observed, with a greater proportion of higher social class students amongst the white students than amongst the minority ethnic students (OR=1.42, 95% CI=1.30, 1.55). This was more marked in dentistry (OR=1.48, 95% CI=1.22, 1.79) than in medicine (OR=1.35, 95% CI=1.22, 1.49). More students from higher social class backgrounds were observed in medicine than in dentistry amongst the black (OR=1.55, 95% CI=0.59, 4.00), Indian (OR=2.04, 95% CI=1.58, 2.62) and white (OR=1.44, 95% CI=1.26, 1.64) groups. Conclusions Significant inter-ethnic differences are observed in the social background of students entering medicine and dentistry. Dentistry accepted a greater proportion of students from lower social class backgrounds and from black and minority ethnic groups.

关键词：非洲裔美国人非洲大陆世系人群亚洲/人种学人种群/统计学和数值数据欧洲大陆世系人群少数民族/统计学和数值数据比值比回顾性研究社会阶级学生牙科/统计学和数值数据学生医科/统计学和数值数据人类

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A study of prophylactic antibiotic prescribing in National Health Service general dental practice in England

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BRITISH DENTAL JOURNAL 2000年第1期189卷 43-46页

作者： Palmer, NAO Pealing, R Ireland, RS Martin, MV Univ Liverpool Dept Clin Dent Sci Liverpool L69 3BX Merseyside England

Objective To study the use of prophylactic antibiotics by general dental practitioners. Design A postal questionnaire of National Health Service (NHS) general dental practitioners in ten English Health Authorities. Subjects General dental practitioners (GDPs) (1544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. Main outcome measures The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Results Responses to the questionnaires were received from 929 (60.1%) practitioners. Over 40% of general dental practitioners would prescribe prophylactic antibiotics for patients with no relevant medical history for minor oral surgery to prevent postoperative infection. Amoxicillin was the predominant choice of antibiotic in this situation. Between 15-67% of GDPs failed to prescribe prophylactic antibiotics for at risk medically compromised patients. GDPs also prescribed for patients with a medical history not known to be at risk from dental procedures, Over 50% of GDPs however, would seek specialist advice about prophylaxis if they were unsure of the indications and over 90% of GDPs indicated they would use the current recommended regime for antibiotic prophylaxis for patients at risk of infective endocarditis. Conclusions The evidence from this study suggests that a significant number of the practitioners surveyed prescribe prophylactic antibiotics inappropriately, both for surgical procedures and for patients at risk from endocarditis. There is also evidence that practitioners prescribe antibiotic prophylaxis for clinical procedures and medical conditions for which there is little evidence. The results suggest that there is a need for the development of guidelines for practitioners on the appropriate prophylactic use of antibiotics.

关键词：阿莫西林/投药和剂量抗菌药/投药和剂量抗生素预防/统计学和数值数据克林霉素/投药和剂量慢性病患者口腔医疗/统计学和数值数据心内膜炎细菌性/预防和控制红霉素/投药和剂量开业医生牙科/统计学和数值数据公费牙科医疗/统计学和数值数据非必要的操作/统计学和数值数据人类

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Trends in the dental health work force

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第12期130卷 1743-1749页

作者： Brown, LJ Lazar, V Amer Dent Assoc Hlth Fdn Hlth Policy Resources Ctr Chicago IL 60611 USA

The dental workforce is changing in number and composition, and these changes may influence the future of dental practice. In this article, we will provide trends in and projections for the U.S. dental work force. However, simply focusing on the total change in numbers will not tell the whole story. Since the 1970s, different trends in the dental work force have occurred. Therefore, we will look at trends in dental school enrollments, graduates, women's participation in dentistry, full-time vs, part-time status, employment status and dentists' age distribution. We also will present projections for the dental work force as derived from the American Dental Association's Dental Workforce Model.(1).

关键词：年龄分布牙科学牙医师/统计学和数值数据牙医师/供应和分配牙医师女/统计学和数值数据人种群/统计学和数值数据性别分布学生牙科/统计学和数值数据美国女(雌)性人类男(雄)性

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